During the last 2,000 years, three great bubonic plague pandemics have resulted in social and economic upheavals that are unmatched by those caused by any armed conflict or any other infectious disease. The contagious nature of plague led to the belief that the only way security could be achieved was total isolation of the sick. Plague-infected rodents, now assisted by modern steamships and railways, quickly spread the disease to the rest of the world. In the three pandemics, it is estimated that rat-borne bubonic plague killed more than 200 million people. Agriculture could not keep up with the population rise, and over the next century famines occurred every few years. The result was poverty and misery, especially in the crowded and filthy cities. Deaths from plague radically reduced the average life expectancy from 35 or 40 years to 20. Medieval society had four kinds of medical practitioners: academic physicians, who knew theory but did not care for the sick; surgeons, who learned their trade as apprentices and who were the principal caregivers of the sick; barbers, who did bloodletting and minor surgery; and those who practiced folk medicine, mostly women.

The rat killer (from a 17th century drawing by Jan Georg van Vliet) through the course of time becomes the children's storybook character the Pied Piper. (Courtesy of the National Library of Medicine.)

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Figure 4.2

The rat killer (from a 17th century drawing by Jan Georg van Vliet) through the course of time becomes the children's storybook character the Pied Piper. (Courtesy of the National Library of Medicine.)